Medicaid expansion brings staffing challenges

Local governments are bracing for a surge of families seeking free health services under the Affordable Care Act’s expansion of Medicaid.

Deschutes County Health Services staff, already struggling to retain licensed child care practitioners, say as many as 5,300 additional county residents could join the Oregon Health Plan next year, with up to 2,600 of them signing up in the first three months of 2014. The Oregon Health Plan offers Medicaid services throughout the state.

The 5,300 new OHP patients would be a 23 percent increase in Deschutes County’s caseload.

The goal is to help current staff handle the expected influx of patients. The county will transfer unused OHP funds to pay the staffers for 18 months of work.

Commissioners also approved a half-position to support medical practitioner staff, with existing funds.

Health officials expect to publish job postings for those positions in the coming days.

Health Services administrators on Monday told county commissioners they need more staff to handle the extra caseload expected Jan. 1. That’s when Medicaid eligibility rises to 133 percent of the federal poverty level, a signature staple of national health care reform.

Many of those new, low-income patients in Deschutes County will need behavioral health services like addiction treatment, and psychiatric care for themselves and their children, DeAnn Carr, deputy director of Deschutes County Health Services’ behavioral health division, told commissioners during a work session.

“The challenge for providing care is making sure we have adequate capacity in our system to serve the new level of need,” Carr said.

That issue is playing out across the country. Twenty-five states and the District of Columbia are expanding Medicaid eligibility, according to the Kaiser Family Foundation.

In Oregon, expanding OHP will more than double the level of federal health care spending in the state by 2017, an Oregon Health & Science University study of the Affordable Care Act’s financial impact, published earlier this year, concluded.

But pinpointing the number of newly eligible OHP patients who will actually come to Deschutes County Health Services for care is an immense challenge, Carr said.

The department is expecting a new mix of county residents with addiction and mental health issues. But “everything at this point is an estimate,” she said. “We’re not sure at this time what (caseloads) are going to look like.”

Medicaid-eligible residents tend to bounce on and off the Oregon Health Plan rolls. Despite the need for health services among lower-income families, as many as one-third of eligible patients fail to renew their OHP benefits each year.

Commissioners voted unanimously to add the behavioral health positions. But they also said not having a clear sense of the caseload was likely to make health department staffing a lingering issue in the coming years. County health staff levels have already increased 32 percent over the last five years.

“My concern is bringing in more staff, and not knowing what staff needs are going to be in the future,” Commissioner Tammy Baney said. “We don’t want to end up with layoffs.”

But commissioners said they recognized the need to be ready for new patients, and can try to piece together longer-term staff needs in the next round of budget negotiations.

“There’s an unknown here,” Deschutes County Administrator Tom Anderson said during the work session. But the county “needs to be ready on Jan. 1.”